Schizophrenia

Overview

Schizophrenia is a complex mental illness that affects how a person thinks, feels, behaves and relates to others. The illness occurs in both men and women, but it is slightly more common in men.

The first episode typically occurs in the late teens to early twenties—usually earlier for men than for women. People can also develop the illness later in life. As many as one person out of 100 may experience schizophrenia.

Signs & Symptoms

Schizophrenia includes “positive” and “negative” symptoms of psychosis, as well as cognitive symptoms.

Positive symptoms are those that add to or distort the person’s normal functioning.

Cognitive symptoms include difficulties with attention, concentration and memory.

Causes & Risk Factors

It is not known for certain what causes schizophrenia, but like most other mental health problems, researchers believe that a combination of biological and environmental factors contribute to its development. Research has shown that:

The risk is higher when a close family member has the illness.

Schizophrenia may be influenced by brain development factors before and around the time of birth, and during childhood and adolescence.

People who have experienced social hardship or trauma, particularly during childhood, have a higher risk.

Cannabis use increases the risk of developing schizophrenia in youth and of triggering an earlier onset of the illness in people who are genetically vulnerable.

Being born or spending one’s childhood in an urban environment, rather than a rural one, increases the risk.

Particular immigrant and refugee groups in Ontario may have a higher risk of developing psychotic disorders such as schizophrenia.

Exactly how these risk factors interact to cause schizophrenia is not yet fully understood.

Diagnosis & Treatment

Diagnosis

To arrive at a diagnosis, a physician or psychologist asks structured questions about how the person is thinking and behaving (an assessment). The clinician may also gather information from family members or others who are familiar with the person’s history.

A diagnosis of schizophrenia is based on:

the information gathered

ruling out other possible explanations

the physician or psychologist’s clinical judgment

certain symptoms, described above, that have been present for at least one month and last for at least six months

symptoms that are severe enough to have an impact on the person’s social, educational or occupational functioning and abilities.

Research has shown that the earlier a person can get a correct diagnosis and treatment for schizophrenia, the better the long-term outcome.

Treatment

Medication is often the first treatment for schizophrenia. The main medications used to treat symptoms of schizophrenia are antipsychotics. They may be used in combination with medications for other mental health symptoms, such as mood stabilizers, sedatives and antidepressants, and medications to help with the side-effects of antipsychotics.

Psychosocial therapies and supports help people to develop recovery skills, such as setting and achieving goals. They include psychoeducation, cognitive-behavioural therapy, cognitive adaptation training, concurrent disorders treatment and family therapy and supports.

People with schizophrenia may need to be admitted to hospital at times—for example, if a person is aggressive or suicidal or is not looking after their own basic needs. Patients may be admitted voluntarily or, in certain risk situations, involuntarily. A typical hospital stay may last between a few days and several weeks. During this time, goals and plans for treatment and recovery will be identified.

When the person returns home, intensive and community supports may be available, if needed. These can help the person to make the transition back to the community and provide ongoing support.

The way we think of schizophrenia has changed over time. Where once it was viewed as a chronic and deteriorating condition requiring lifelong care, now recovery is considered to be a realistic possibility. Recovery is seen as a process of gaining control over one’s life and finding meaning, rather than as the total absence of symptoms.

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